Intracranial Pressure and Cerebral Blood Flow Monitoring after Bilateral Decompressive Craniectomy in Patients with Acute Massive Brain Swelling
Journal of Korean Neurosurgical Society
;
: 295-306, 2001.
Artículo
en Coreano
| WPRIM
| ID: wpr-42531
ABSTRACT
OBJECTIVES:
The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. MATERIALS ANDMETHODS:
Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period.RESULTS:
The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to 53.1+/-15.8% of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure 16.4+/-10.5% of the initial pressure(ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to 20.2+/-22.6%(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments.CONCLUSION:
Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.
Texto completo:
Disponible
Índice:
WPRIM (Pacífico Occidental)
Asunto principal:
Periodo Posoperatorio
/
Encéfalo
/
Edema Encefálico
/
Presión Intracraneal
/
Punciones
/
Mortalidad
/
Presión Ventricular
/
Coma
/
Selección de Paciente
/
Descompresión Quirúrgica
Tipo de estudio:
Estudio pronóstico
Límite:
Humanos
Idioma:
Coreano
Revista:
Journal of Korean Neurosurgical Society
Año:
2001
Tipo del documento:
Artículo
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